What is a diaper rash?
Does your baby have a rash in the diaper area? Is the skin over the buttocks, genitalia, inner thighs, or lower abdomen looking red, bumpy with possible peeling? This is most probably a diaper rash….a very common condition seen in infants and toddlers. Although it can occur in any child wearing diapers, it is most common in babies who are between 9 and 12 months old.
Why does a diaper rash occur?
Diaper rashes occur as a result of either one or a combination of the following reasons: skin irritation, allergic reactions, fungal infection, and/or mechanical friction.
So let’s start at the very beginning… what do we use a diaper for? Well… to contain urine and stools. Unfortunately, in doing so, the diaper creates a warm wet environment around a baby’s bottom that is not good for the skin that is in direct contact with it.
Excessive moisture damages the outermost layer of the skin which is the main barrier between the body and the environment. In addition, bacteria normally present in the stools produce an enzyme that breaks down urine to ammonia which increases the pH level. This altered pH level activates digestive enzymes in the stools which directly irritate and damage the skin, causing the skin to become inflamed. This is how the most common type of diaper rash known as irritant contact dermatitis occurs.
Once the skin barrier is damaged, it becomes easier for chemical irritants and micro-organisms to enter the skin further increasing skin irritation. Certain ingredients such as dyes or elastics in the diaper, and fragrances or preservatives in diaper wipes or creams can cause additional allergic reactions. Secondary infection of the damaged skin by a normally occurring fungus called Candida results in fungal diaper rash. Lastly, the wet macerated skin also becomes more sensitive to frictional damage from the diaper rubbing against the skin.
Irritant diaper rash versus fungal diaper rash
Irritant diaper rash occurs more frequently when the baby has diarrhea or during weaning when the stool composition changes. In irritant contact dermatitis, the groin folds are not in direct contact with the urine or stool in the diaper and are classically spared.
Fungal diaper rashes are more common in children who have a history of recent antibiotic use as antibiotics given to a baby or a breastfeeding mother can kill off the “good” bacteria that prevent an overgrowth of Candida. Unlike irritant diaper rash, a fungal diaper rash is usually worse in the groin folds with small red raised dots spreading beyond the main part of the rash.
Management and prevention
Diaper rashes generally subside with a few simple changes in diapering routines.
1. Change diapers frequently to limit contact of the skin with urine and stool— ideally every 2 hours or so — and after every stool.
2. Clean the skin gently during diaper changes. You can use plain water, a gentle cleanser, or alcohol and fragrance-free wipes. Do not rub.
3. Pat the skin gently with a soft cloth or leave the baby open for a while to dry the skin completely before putting on the next diaper.
4. Apply a thick layer of any diaper cream that has Zinc oxide or simple petroleum jelly (Vaseline). These are barrier creams which minimize friction and more importantly prevent chemical irritants and moisture from coming in contact with the skin.
5. Choose a highly absorbent diaper – the more absorbent the diaper, the better job it does of keeping the skin dry. You can use either cloth or disposable as there is no evidence at present that one is better than the other.
6. Make sure the diaper isn’t too tight.
In case the diaper rash does not heal with these general measures, visit your doctor who may prescribe low-potency topical corticosteroids and antifungals as necessary.
Note:
– Avoid using baby powder in the rash area. Powder can accumulate in the skin folds and hold moisture making it easier for bacteria to grow.
– For cloth diapers, avoid using more detergent than required, avoid fabric softeners and rinse thoroughly to remove any traces of detergent which may irritate your baby’s skin.